NORTHEAST FLORIDA HEALTH SERVICES INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- NORTHEAST FLORIDA HEALTH SERVICES INC (EIN 55-0799729)
- Tax period
- 2021-11-01 to 2022-10-31
- Filed
- 2023-09-07
- IRS object ID
- 202332509349300513
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-09-07T08:37:38-05:00 | ReturnTs |
| Tax Period End | 2022-10-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 593204548 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAMES MOORE & COPL | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 121 EXECUTIVE CIRCLE | AddressLine1Txt |
| City | DAYTONA BEACH | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 321141180 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-11-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550799729 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHEAST FLORIDA HEALTH SERVICES INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | NORT | BusinessNameControlTxt |
| Phone | 3862026025 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1205 S WOODLAND BLVD 3 | AddressLine1Txt |
| City | DELAND | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 327207464 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LAURIE ASBURY | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 3862026025 | PhoneNum |
| Signature | 2023-09-05 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | LAURIE | PersonFirstNm |
| Person Last | ASBURY | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JAMES A HALLERAN | PreparerPersonNm |
| PTIN | P00005496 | PTIN |
| Phone | 3862574100 | PhoneNum |
| Preparation | 2023-09-05 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAMILY HEALTH SOURCE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | LAURIE ASBURY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1205 S WOODLAND BLVD 3 | AddressLine1Txt |
| City | DELAND | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 327207464 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $12,654,990 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FAMILYHEALTHSOURCE.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2004 | FormationYr |
| Legal Domicile State | FL | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE QUALITY PRIMARY HEALTH CARE SERVICES, ACCESSIBLE TO ALL PERSONS IN PIERSON, DELAND, DAYTONA, AND DELTONA, FLORIDA, BY PROMOTING INDIVIDUAL HEALTH WELLNESS SERVICES, EDUCATION, AND RESOURCES. WE ARE DEDICATED TO PROVIDING QUALITY CARE TO ALL, REGARDLESS OF AGE, RACE, INCOME, EMPLOYMENT OR INSURANCE. SERVICES ARE RENDERED REGARDLESS OF ABILITY TO PAY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 116 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,467,295 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,831,970 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $7,259,740 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $8,822,868 | CYProgramServiceRevenueAmt |
| PY Investment Income | $230 | PYInvestmentIncomeAmt |
| CY Investment Income | $152 | CYInvestmentIncomeAmt |
| PY Other Revenue | $274 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $10,727,539 | PYTotalRevenueAmt |
| CY Total Revenue | $12,654,990 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $11,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,407,834 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,894,141 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,310,957 | PYOtherExpensesAmt |
| CY Other Expenses | $4,364,972 | CYOtherExpensesAmt |
| PY Total Expenses | $10,718,791 | PYTotalExpensesAmt |
| CY Total Expenses | $11,270,113 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $8,748 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,384,877 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $5,252,844 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,518,060 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,111,615 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $991,954 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,141,229 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,526,106 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE QUALITY PRIMARY HEALTH CARE SERVICES, ACCESSIBLE TO ALL PERSONS IN PIERSON, DELAND, DAYTONA, AND DELTONA, FLORIDA, BY PROMOTING INDIVIDUAL HEALTH WELLNESS SERVICES, EDUCATION, AND RESOURCES. WE ARE DEDICATED TO PROVIDING QUALITY CARE TO ALL, REGARDLESS OF AGE, RACE, INCOME, EMPLOYMENT OR INSURANCE. SERVICES ARE RENDERED REGARDLESS OF ABILITY TO PAY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $7,777,430 | ExpenseAmt |
| Grant | $11,000 | GrantAmt |
| Revenue | $8,822,868 | RevenueAmt |
| Desc | FAMILY HEALTH SOURCE MEETS THE PEDIATRIC THRU GERIATRIC PRIMARY CARE NEEDS OF VOLUSIA COUNTY RESIDENTS. OUR MEDICAL CENTERS ARE IN PIERSON, DELTONA, DELAND, AND DAYTONA AND ARE OPERATED BY NORTHEAST FLORIDA HEALTH SERVICES, INC. DBA FAMILY HEALTH SOURCE. OUR SERVICES INCLUDE (BUT ARE NOT LIMITED TO): ADULT PRIMARY MEDICAL CARE AND SCREENINGS (INCLUDING ADULT PHYSICALS), BEHAVIORAL HEALTH INTEGRATION SERVICES, OBSTETRICS (PRENATAL/POSTPARTUM CARE), CONTRACEPTION, DENTAL SERVICES, PHARMACY SERVICES, TRANSLATION, TRANSPORTATION, CASE MANAGEMENT, ELIGIBILITY AND OUTREACH, AFTER HOURS, DIAGNOSTIC LAB, GYNECOLOGICAL CARE, VETERAN'S CHOICE PROGRAMS, PEDIATRICS, OUTPATIENT SERVICES AND PROCEDURES, PERSCRIPTION DISCOUNT, SPORTS PHYSICALS, WELL CHILD, WELL WOMAN, MENOPAUSAL MANAGEMENT, CARE FOR HYPERTENSION, HYPERLIPIDEMIA, DIGESTIVE, UROLOGICAL, MUSCULAR/SKELETAL, AND PULMONARY DISEASE. | Desc |
| Total Program Service Expenses | $7,777,430 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 116 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAURIE ASBURY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3862026025 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1205 S WOODLAND BLVD 3 | AddressLine1Txt |
| City | DELAND | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 327207464 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| CARMEN RIVERA-SPELORZI | |||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| VIVIAN CAMPBELL | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| CATHY CORTES | |||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| REGINA SANTILLI | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| NIGEL HINDS | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| VICTOR RAMOS | |||||||
| VICE-CHAIR, UNTIL 8/2022 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DAVID SANTIAGO | |||||||
| CDO, UNTIL 5/2022 | 40.00 | Yes (X) | $142,850 | $0 | $13,174 | ||
| HIPOLITO VALDEZ | |||||||
| CFO | 40.00 | Yes (X) | $164,836 | $0 | $24,719 | ||
| LAURIE ASBURY | |||||||
| CEO | 40.00 | Yes (X) | $201,012 | $0 | $25,553 | ||
| JOHN MICHAEL HAM-YING MD | |||||||
| CMO/MD | 40.00 | Yes (X) | $217,692 | $0 | $16,845 | ||
| BRUINES RAMIREZ | |||||||
| COO, AS OF 9/2022 | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| LEONEL TORRES | |||||||
| DENTAL DIRECTOR | 40.00 | $182,168 | $0 | $8,378 | Yes (X) | ||
| TERESA ROJAS-SANCHEZ | |||||||
| PROVIDER | 40.00 | $171,196 | $0 | $27,980 | Yes (X) | ||
| BRUNO MANCINI | |||||||
| PROVIDER | 40.00 | $194,539 | $0 | $24,649 | Yes (X) | ||
| MICHELLE MOLL | |||||||
| PHARMACY DIRECTOR | 40.00 | $143,071 | $0 | $21,837 | Yes (X) | ||
| ERIN HOUGH | |||||||
| PROVIDER | 40.00 | $171,380 | $0 | $11,871 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,588,744 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $175,006 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 13 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| DELTONA WELLNESS LP CO WEISSMAN CORP | |||||
| 17 COPPERBEECH LANE | LAWRENCE | NY | 11559 | RENT | $314,721 |
| SWANN LANDING LLC | |||||
| 2441 SLEEPY OAK LANE | DELAND | FL | 32720 | RENT | $207,916 |
| ECLINICALWORKS LLC | |||||
| PO BOX 847950 | BOSTON | MA | 02284 | IT SERVICES | $190,222 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $3,831,665 | GovernmentGrantsAmt |
| All Other Contributions | $305 | AllOtherContributionsAmt |
| Total Contributions | $3,831,970 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621400 | $6,878,974 | $6,878,974 |
| 340B CONTRACT REVENUE | 621400 | $1,943,734 | $1,943,734 |
| MEDICAL RECORDS | 621400 | $160 | $160 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $8,822,868 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $152 | TotalRevenueColumnAmt |
| Exclusion | $152 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,654,990 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,822,868 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $152 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,000 | TotalAmt |
| Program Services | $11,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $761,156 | TotalAmt |
| Program Services | $608,925 | ProgramServicesAmt |
| Management And General | $152,231 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,992,010 | TotalAmt |
| Program Services | $2,904,986 | ProgramServicesAmt |
| Management And General | $2,087,024 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,159 | TotalAmt |
| Program Services | $40,829 | ProgramServicesAmt |
| Management And General | $16,330 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $652,676 | TotalAmt |
| Program Services | $474,745 | ProgramServicesAmt |
| Management And General | $177,931 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $431,140 | TotalAmt |
| Program Services | $262,644 | ProgramServicesAmt |
| Management And General | $168,496 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $132,110 | TotalAmt |
| Program Services | $89,835 | ProgramServicesAmt |
| Management And General | $42,275 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,041 | TotalAmt |
| Program Services | $43,756 | ProgramServicesAmt |
| Management And General | $23,285 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $433,186 | TotalAmt |
| Program Services | $311,900 | ProgramServicesAmt |
| Management And General | $121,286 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,114 | TotalAmt |
| Program Services | $81,114 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $241,786 | TotalAmt |
| Program Services | $163,827 | ProgramServicesAmt |
| Management And General | $77,959 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $150,381 | TotalAmt |
| Program Services | $103,223 | ProgramServicesAmt |
| Management And General | $47,158 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $812,335 | TotalAmt |
| Program Services | $552,420 | ProgramServicesAmt |
| Management And General | $259,915 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,911 | TotalAmt |
| Program Services | $24,438 | ProgramServicesAmt |
| Management And General | $10,473 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,347 | TotalAmt |
| Program Services | $5,676 | ProgramServicesAmt |
| Management And General | $2,671 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $383,035 | TotalAmt |
| Program Services | $311,291 | ProgramServicesAmt |
| Management And General | $71,744 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,132 | TotalAmt |
| Program Services | $53,130 | ProgramServicesAmt |
| Management And General | $25,002 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL DRUGS & SUPPLIE | $940,332 | $940,332 | |
| MEDICAL RECORD & BILLIN | $283,828 | $193,237 | $90,591 |
| REPAIRS & MAINTENANCE | $215,947 | $146,844 | $69,103 |
| BAD DEBT EXPENSE | $202,530 | $202,530 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $299,957 | TotalAmt |
| Program Services | $250,748 | ProgramServicesAmt |
| Management And General | $49,209 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,270,113 | TotalAmt |
| Program Services | $7,777,430 | ProgramServicesAmt |
| Management And General | $3,492,683 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $774,595 | BOYAmt |
| EOY | $2,807,549 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $502,932 | BOYAmt |
| EOY | $503,373 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,039,756 | BOYAmt |
| EOY | $470,996 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,232 | BOYAmt |
| EOY | $44,225 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $62,177 | BOYAmt |
| EOY | $88,836 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $3,924,917 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,370,741 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,799,767 | BOYAmt |
| EOY | $2,554,176 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $49,385 | BOYAmt |
| EOY | $48,905 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,252,844 | BOYAmt |
| EOY | $6,518,060 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $934,084 | BOYAmt |
| EOY | $852,571 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $177,531 | BOYAmt |
| EOY | $139,383 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,111,615 | BOYAmt |
| EOY | $991,954 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,141,229 | BOYAmt |
| EOY | $5,526,106 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,141,229 | BOYAmt |
| EOY | $5,526,106 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,252,844 | BOYAmt |
| EOY | $6,518,060 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,384,877 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,112,130 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,418,242 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,633,477 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,467,295 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,831,970 | CurrentTaxYearAmt |
| Total | $15,463,114 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,112,130 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,418,242 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,633,477 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,467,295 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,831,970 | CurrentTaxYearAmt |
| Total | $15,463,114 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $15,463,114 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $533 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $722 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $885 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $230 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $152 | CurrentTaxYearAmt |
| Total | $2,522 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $15,465,636 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $35,723,281 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.99980 | PublicSupportCY170Pct |
| Public Support PY170 | 0.99980 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $451,540 | OtherCostOrOtherBasisAmt |
| Depreciation | $255,140 | DepreciationAmt |
| Book Value | $196,400 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,570,168 | OtherCostOrOtherBasisAmt |
| Depreciation | $811,327 | DepreciationAmt |
| Book Value | $1,758,841 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $635,729 | OtherCostOrOtherBasisAmt |
| Depreciation | $304,274 | DepreciationAmt |
| Book Value | $331,455 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $267,480 | OtherCostOrOtherBasisAmt |
| Book Value | $267,480 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,554,176 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $12,458,184 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $5,724 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $5,724 | RevenueNotReportedAmt |
| Revenue Subtotal | $12,452,460 | RevenueSubtotalAmt |
| Other Revenues Not Included | $202,530 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $202,530 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $12,654,990 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $11,073,307 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $5,724 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $5,724 | ExpensesNotReportedAmt |
| Expenses Subtotal | $11,067,583 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $202,530 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $202,530 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $11,270,113 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE ORGANIZATION IS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, INCOME EARNED IN THE FURTHERANCE OF THE ORGANIZATION'S TAX-EXEMPT PURPOSE IS EXEMPT FROM FEDERAL INCOME TAXES AND THE FINANCIAL STATEMENTS CONTAIN NO PROVISION OR LIABILITY FOR INCOME TAXES. THE ORGANIZATION FILES INCOME TAX RETURNS IN THE U.S. FEDERAL JURISDICTION. THE ORGANIZATION'S RETURNS FOR THE PAST THREE YEARS ARE SUBJECT TO EXAMINATIONS BY TAX AUTHORITIES AND MAY CHANGE UPON EXAMINATION. THE ORGANIZATION HAS REVIEWED AND EVALUATED THE RELEVANT TECHNICAL MERITS OF EACH OF ITS TAX POSITIONS IN ACCORDANCE WITH ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA FOR ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, AND DETERMINED THAT THERE ARE NO UNCERTAIN TAX POSITIONS THAT WOULD HAVE A MATERIAL IMPACT ON THE FINANCIAL STATEMENTS OF THE ORGANIZATION. THE ORGANIZATION RECOGNIZES INTEREST AND PENALTIES IN OPERATING EXPENSES. DURING THE YEAR ENDED OCTOBER 31, 2022, THERE WERE NO INTEREST AND PENALTIES INCURRED. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX 202,530. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX 202,530. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | SCHOLARSHIPS FOR STUDENTS | GrantTypeTxt |
| Recipient | 11 | RecipientCnt |
| Cash Grant | $11,000 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION MAINTAINS RECORDS OF THE STUDENTS SELECTED BY THE SCHOOLS TO RECEIVE THE SCHOLARSHIPS. THE ORGANIZATION IS CURRENTLY WORKING WITH THE SCHOOLS TO PROVIDE REPORTS FROM THE STUDENTS AFTER THEIR FIRST SEMESTER OF COLLEGE WHICH WILL PROVIDE A STATEMENT OF HOW THE SCHOLARSHIP HAS HELPED THEM IN THEIR PURSUIT OF HIGHER EDUCATION. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOHN MICHAEL HAM-YING MD | ||||||||||||||
| CMO/MD | $212,628 | $0 | $5,064 | $0 | $0 | $0 | $0 | $0 | $16,845 | $0 | $234,537 | $0 | $0 | $0 |
| LAURIE ASBURY | ||||||||||||||
| CEO | $187,166 | $0 | $13,846 | $0 | $0 | $0 | $5,769 | $0 | $19,784 | $0 | $226,565 | $0 | $0 | $0 |
| BRUNO MANCINI | ||||||||||||||
| PROVIDER | $190,693 | $0 | $3,846 | $0 | $0 | $0 | $2,000 | $0 | $22,649 | $0 | $219,188 | $0 | $0 | $0 |
| TERESA ROJAS-SANCHEZ | ||||||||||||||
| PROVIDER | $167,734 | $0 | $3,462 | $0 | $0 | $0 | $5,331 | $0 | $22,649 | $0 | $199,176 | $0 | $0 | $0 |
| LEONEL TORRES | ||||||||||||||
| DENTAL DIRECTOR | $178,025 | $0 | $4,143 | $0 | $0 | $0 | $1,300 | $0 | $7,078 | $0 | $190,546 | $0 | $0 | $0 |
| HIPOLITO VALDEZ | ||||||||||||||
| CFO | $160,923 | $0 | $3,913 | $0 | $0 | $0 | $4,935 | $0 | $19,784 | $0 | $189,555 | $0 | $0 | $0 |
| ERIN HOUGH | ||||||||||||||
| PROVIDER | $168,111 | $0 | $3,269 | $0 | $0 | $0 | $0 | $0 | $11,871 | $0 | $183,251 | $0 | $0 | $0 |
| MICHELLE MOLL | ||||||||||||||
| PHARMACY DIRECTOR | $139,685 | $0 | $3,386 | $0 | $0 | $0 | $2,053 | $0 | $19,784 | $0 | $164,908 | $0 | $0 | $0 |
| DAVID SANTIAGO | ||||||||||||||
| CDO, UNTIL 5/2022 | $139,397 | $0 | $3,453 | $0 | $0 | $0 | $1,212 | $0 | $11,962 | $0 | $156,024 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | THE CEO IS EVALUATED ANNUALLY BY THE BOARD OF DIRECTORS AND COMPENSATION IS BASED ON THE RESULTS OF THAT EVALUATION. OFFICER COMPENSATION ALSO INCLUDES COMPARABILITY DATA PRIMARILY WITHIN THE FQHC SPACE ASSOCIATED WITH MARKET CAPITALIZATION. SOME OFFICERS ADDITIONALLY HAVE WRITTEN EMPLOYMENT CONTRACTS. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS REVIEWED BY BOTH THE CEO AND THE CFO. THE FORM 990 IS THEN PRESENTED TO THE BOARD OF DIRECTORS FOR BOARD APPROVAL. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH YEAR A RELATED PARTY LETTER IS SENT TO EACH BOARD MEMBER DURING THE AUDIT. IF A RESPONSE INDICATES A CONFLICT OF INTEREST, IT IS DIRECTED TO THE CEO AND CFO. ALSO, EACH BOARD MEMBER SIGNS A CONFLICT OF INTEREST STATEMENT. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO IS EVALUATED ANNUALLY BY THE BOARD OF DIRECTORS AND COMPENSATION IS BASED ON THE RESULTS OF THAT EVALUATION. OFFICER COMPENSATION ALSO INCLUDES COMPARABILITY DATA PRIMARILY WITHIN THE FQHC SPACE ASSOCIATED WITH MARKET CAPITALIZATION. SOME OFFICERS ADDITIONALLY HAVE WRITTEN EMPLOYMENT CONTRACTS. THE MEDICAL STAFF ARE ANNUALLY REVIEWED BY THE CEO AND WAGES ARE DETERMINED BASED ON THAT REVIEW. |
| FORM 990, PART VI, SECTION C, LINE 19 | DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |